Tab%25252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It is available as a conventional tablet and an orally disintegrating tablet (ODT). ## Primary Indications Acute treatment of migraine attacks with or without aura in adults and pediatric patients (aged 6 to 17 years). ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg at the onset of migraine. * **Redosing:** If symptoms recur after at least 2 hours, a second dose may be taken. * **Maximum Dose:** 30 mg in a 24-hour period. ## Pediatric Dosing * **Patients < 40 kg:** 5 mg. * **Patients ≥ 40 kg:** 10 mg. * **Redosing:** One additional dose may be taken after at least 2 hours. * **Maximum Dose:** Do not exceed 2 doses in 24 hours. ## Dose Adjustments * **Hepatic Impairment:** Use with caution in mild-to-moderate impairment. Not recommended in severe impairment. * **Propranolol Use:** Propranolol increases rizatriptan plasma concentrations. Limit dose to 5 mg (maximum 15 mg in 24 hours). ## Contraindications * History of ischemic heart disease (e.g., MI, angina, silent ischemia). * Coronary artery vasospasm (Prinzmetal’s angina). * Wolff-Parkinson-White syndrome or arrhythmias associated with cardiac accessory conduction pathways. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease. * Ischemic bowel disease. * Uncontrolled hypertension. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type drug. * Use within 2 weeks of discontinuing MAO inhibitors. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, fatigue, dry mouth, nausea. * **Serious:** Coronary vasospasm, transient myocardial ischemia, arrhythmias, myocardial infarction, serotonin syndrome (when used with SSRIs/SNRIs). ## Key Drug Interactions * **MAO Inhibitors:** Risk of serotonin syndrome and increased rizatriptan exposure. * **Propranolol:** Increases rizatriptan levels; requires dose reduction. * **SSRIs/SNRIs:** Increased risk of serotonin syndrome; monitor clinical status. * **Ergot-containing drugs:** Additive vasospastic effects; separate by at least 24 hours. ## Monitoring * Monitor blood pressure if risk factors for cardiovascular disease exist. * Observe for symptoms of serotonin syndrome (confusion, hyperreflexia, tachycardia, tremors). * Evaluate for medication overuse headache if used >10 days per month. ## Clinical Pearls * The ODT formulation does not require water but must be placed on the tongue to dissolve; avoid breaking the blister pack until immediately before use. * Efficacy is generally higher if the drug is taken as soon as head pain begins. * Rizatriptan is not indicated for the prophylaxis of migraine or for the treatment of cluster headaches. * Patients should be counseled that "chest tightness" or pressure is a common sensory side effect of triptans, but symptoms suggestive of angina require immediate medical evaluation. *** *Disclaimer: This information is for educational purposes and does not replace medical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before prescribing or administering medication.*